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Advances in scans

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User
Posted 16 Nov 2017 at 23:20

Although scans may never reveal minuscule dispersed cancer cells, advances have been made in detecting small tumours in men with PCa. In the UK we have very few hospitals that can offer the 68 Gallium PSMA scan which for a relatively short time has been regarded as possibly the best scan.  Yet already there is a second generation PSMA scan termed 18F DCFPyL PET/CT which has been produced by John Hopkins in the USA that is said in small comparative studies to reveal tumors that were not seen in the 68 Gallium scan.  An arrangement has been made with John Hopkins to enable the use of this scan at 30 centres in Australia and it is likely to become available elsewhere but when available in the UK?  It does require a cyclotron to produce the tracer unlike the 68 Gallium scan which can manage with a generator, close to user as that tracer has a quite short half life. https://www.ncbi.nlm.nih.gov/pubmed/26013479


 

Barry
User
Posted 16 Nov 2017 at 23:20

Although scans may never reveal minuscule dispersed cancer cells, advances have been made in detecting small tumours in men with PCa. In the UK we have very few hospitals that can offer the 68 Gallium PSMA scan which for a relatively short time has been regarded as possibly the best scan.  Yet already there is a second generation PSMA scan termed 18F DCFPyL PET/CT which has been produced by John Hopkins in the USA that is said in small comparative studies to reveal tumors that were not seen in the 68 Gallium scan.  An arrangement has been made with John Hopkins to enable the use of this scan at 30 centres in Australia and it is likely to become available elsewhere but when available in the UK?  It does require a cyclotron to produce the tracer unlike the 68 Gallium scan which can manage with a generator, close to user as that tracer has a quite short half life. https://www.ncbi.nlm.nih.gov/pubmed/26013479


 

Barry
User
Posted 24 Dec 2017 at 13:37

I was really wanting to confine this thread to scans as a means of diagnosis though because many of us and I include myself in this, are unaware of the increasing number of scans on trial/becoming available. A person in the US was told there that the best scan in his circumstances of rising PSA despite having had several major treatments, was one by 'Blue Earth'. It was developed in the UK where it is on trial at some major UK Hospitals and in the US, where it has now been approved by the FDA. It is called Axumin (fluciclovine F18) and a link to preliminary results it is given here. http://www.blueearthdiagnostics.com/blue-earth-diagnostics-initial-results-falcon-trial-show-61-patients-suspected-recurrent-prostate-cancer-treatment-plan-changed-following-fluciclovine-18f-petct-scan/
For further interest http://paact.help/new-pet-scan-approved-for-prostate-cancer-for-psa-recurrence-after-treatment/
So Axumin is another possibility.
I have to confess a particular interest in these more advanced scans as I need to decide which scan to plump for to hopefully learn if my PCa can be dealt with other than by systemic HT.

Edited by member 24 Dec 2017 at 13:41  | Reason: Not specified

Barry
User
Posted 23 Dec 2017 at 22:30

I think Ga68-PSMA-PET is already very sensitive to detect metastases or local recurrence.
More important is to research how to use it as ligand for radionuclide therapy.

http://www.sciencedirect.com/science/article/pii/S0022534716033619

User
Posted 24 Dec 2017 at 01:26

Yes Chris, as I said at the outset, scans are not so advanced that they will show everything for everybody but more importantly for men in a similar situation to you, perhaps PSMA can be used in a way to distribute targeted radionuclide therapy as here for example http://jnm.snmjournals.org/content/57/8/1170.short

Barry
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User
Posted 17 Nov 2017 at 08:48

Excellent information Barry and I'm sure will be of interest to all of us

We can't control the winds - but we can adjust our sails
User
Posted 23 Dec 2017 at 22:30

I think Ga68-PSMA-PET is already very sensitive to detect metastases or local recurrence.
More important is to research how to use it as ligand for radionuclide therapy.

http://www.sciencedirect.com/science/article/pii/S0022534716033619

User
Posted 23 Dec 2017 at 22:49

I think like with everything in the UK Barry , it has to prove it’s worth before it is rolled out all over the country. You have to remember all the research is done on a relatively small group. Yes some awesome results , yet still people like me annoyingly showing zero spread with both Choline and PSMA despite rapidly rising psa and >3 in both cases. As my Onco said , I have aggressive PCa which will need treating , with a doubling time just over 12 weeks. My psa post surgery is 12 now but neither of these scans picked out anything. That sort of feedback slows progress down I’m afraid

User
Posted 24 Dec 2017 at 01:26

Yes Chris, as I said at the outset, scans are not so advanced that they will show everything for everybody but more importantly for men in a similar situation to you, perhaps PSMA can be used in a way to distribute targeted radionuclide therapy as here for example http://jnm.snmjournals.org/content/57/8/1170.short

Barry
User
Posted 24 Dec 2017 at 12:44

I had a PET/CT scan at the RM  PSA 1.7 nothing seen Dec  2016,


Next PET/CT scan PSA 3.1 seen three METS June 2017


 

User
Posted 24 Dec 2017 at 13:37

I was really wanting to confine this thread to scans as a means of diagnosis though because many of us and I include myself in this, are unaware of the increasing number of scans on trial/becoming available. A person in the US was told there that the best scan in his circumstances of rising PSA despite having had several major treatments, was one by 'Blue Earth'. It was developed in the UK where it is on trial at some major UK Hospitals and in the US, where it has now been approved by the FDA. It is called Axumin (fluciclovine F18) and a link to preliminary results it is given here. http://www.blueearthdiagnostics.com/blue-earth-diagnostics-initial-results-falcon-trial-show-61-patients-suspected-recurrent-prostate-cancer-treatment-plan-changed-following-fluciclovine-18f-petct-scan/
For further interest http://paact.help/new-pet-scan-approved-for-prostate-cancer-for-psa-recurrence-after-treatment/
So Axumin is another possibility.
I have to confess a particular interest in these more advanced scans as I need to decide which scan to plump for to hopefully learn if my PCa can be dealt with other than by systemic HT.

Edited by member 24 Dec 2017 at 13:41  | Reason: Not specified

Barry
User
Posted 24 Dec 2017 at 18:01

Thanks Barry
Sadly I was told that next March I won’t be having any sort of PET scan again. Maybe two is enough ? I never looked into whether the injections are deemed dangerous.
I was told by Onco that a full CT and Bone scan will be ample ???
Maybe they decided that the PETs obviously don’t work on me ?

User
Posted 13 Feb 2018 at 03:32

This is a very l o n g presentation basedon many aspects of the PSMA scan. One interesting comment is that it could also replace the need for a bone scan whilst providing so much other info. I found it very interesting so am posting the link :- https://www.youtube.com/watch?v=0H-g047os6c


 

Edited by member 13 Feb 2018 at 03:40  | Reason: Not specified

Barry
User
Posted 19 Jun 2020 at 16:44

I have had Robotic Radical Prostatectomy in Jan 2009. My PSA has been gradually rising and is now 3.1. 


A PSMA PET CT, PELVIC gadolinium MRI and a Whole body MRI has not detected and recurrence. 


I feel a AXUMIN PET Scan will be able to show the way forward to my treatment. 


Can anyone please suggest if it is available in the UK ? under NHS ? it is approved in the NICE guidelines. 


If this is available in the UK privately or in Europe. 


Thank you very much.

User
Posted 19 Jun 2020 at 16:53
Yes, they were running Axumin (FACBC or 18F) scans at St James hospital, Leeds as part of the UK FALCON trial but this is no longer open to new patients. Also take into account that while FACBC performed better than choline at low PSA levels, it wasn't as reliable as PSMA G18 so there is no guarantee that you would get a positive result.

With a PSA of 3.1 and a succession of clear scans, it seems most likely that you have extensive micromets which require systemic rather than radical treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Jun 2020 at 17:53

Thanks for the reply. can you please explain, what do you mean by Sytemic treatment ?


 

User
Posted 19 Jun 2020 at 18:43
Systemic treatment attacks the cancer cells wherever they are in the body .... hormone therapy and chemo. Immunotherapy would be considered a systemic treatment, I think, except it isn't widely available in the UK for prostate cancer yet.

Radical treatment is targeted at the known tumour site(s) - surgery, external radiotherapy, brachytherapy, HIFU, etc
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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